A new study led by UNMC investigators shows that embedding a standardized glucose management protocol into the electronic health record (EHR) can help perioperative care teams better control blood sugar levels for patients with diabetes.
The study, published in the Journal of Diabetes Science and Technology, evaluated more than 1,200 adults with diabetes who underwent non-cardiac surgery before and after the EHR-embedded protocol launched in 2023. The study found a significant improvement in glucose control during surgery and a reduction in preoperative hypoglycemia, all without increasing complications.
“The idea grew out of a recognition that perioperative dysglycemia was both common and difficult to address,” said Troy Wildes, MD, vice chair of perioperative medicine, quality and safety at the UNMC Department of Anesthesiology. “Despite national guidelines, there was no unified, real-time approach built into our everyday workflow. We saw an opportunity to standardize care, reduce practice variability and address monitoring gaps by embedding guidance directly within the EHR.”
This multidisciplinary study was spearheaded by Andjela Drincic, MD, professor at the UNMC Division of Diabetes, Endocrinology and Metabolism, with contributions from hospital medicine, anesthesiology, nursing, pharmacy and information technology. The protocol provides clear direction for glucose monitoring and insulin administration before, during and after surgery.
Melissa McKnight, PharmD, credited the project’s success to its multidisciplinary design. “Collaboration was absolutely vital,” she said. “Surgery and anesthesia workflows are very different from standard inpatient care. Working closely with endocrinology and diabetes specialists allowed us to adapt inpatient diabetes tools to the unique, time-sensitive challenges of the perioperative setting.”
Dr. McKnight, who helped develop the protocol, said building a process that worked for most surgical patients while still allowing flexibility was key. “We needed to make sure the protocol was usable in high-risk case like those in patients with type 1 diabetes while minimizing alert fatigue and keeping it practical for busy clinicians,” she said.
Embedding the protocol directly into the EHR made the process easier for clinicians.
“Instead of searching for separate documents or relying on memory, anesthesia teams could access glucose-monitoring intervals and insulin guidance within the exact order sets they already use,” Dr. Wildes said. “It simplified daily practice, reduced the cognitive load and helped new team members quickly understand expectations.”
Shubham Agarwal, MD, assistant professor at the UNMC Division of Diabetes, Endocrinology and Metabolism, noted the team’s approach demonstrates the feasibility of digitized, evidence-based care pathways. “Our findings show that standardizing perioperative glycemic care through embedded decision support is both practical and impactful,” he said. “It provides a framework for other hospitals looking to deliver consistent, high-quality care in complex, fast-moving clinical settings.”
Better glucose control is associated with fewer surgical site infections, improved wound healing and shorter recoveries, outcomes that the team hopes to study further. “Even though our project wasn’t designed to measure long-term outcomes, improving the underlying processes of care is expected to lead to better recovery and safety,” Dr. Wildes said.
The team is already working on imminent expansion to the Bellevue Medical Center campus and sees broader potential for similar EHR-based decision tools. “This approach can be helpful anywhere complex, rapid decisions are made, from inpatient glycemic management to other aspects of perioperative and critical care,” Dr. Wildes said.
For Dr. Agarwal, the project represents the spirit of UNMC’s innovative culture.
“Anything we can do to automate care and reduce the mental burden on providers helps us deliver safer, more consistent care,” he said. “This work reflects UNMC’s iTEACH values — innovation, teamwork and excellence — by showing how collaboration and technology can improve outcomes for patients across Nebraska and beyond.”